Seven-year survivor with malignant melanoma of the anus without radical surgery

We report a case of a long-term survivor with malignant melanoma of the anus who did not undergo radical surgery. A 71-year-old woman who presented with anal bleeding and anal tumor underwent an excisional biopsy in September 1985. The biopsy specimen was a lobulated, polypoid, pigmented mass 2 cm in diameter, that had been located on the anterior wall of the anus. A satellite nodule 7 mm in diameter was found on the left wall of the anus at the level of the dentate line. Both tumors were histologically diagnosed as malignant melanoma. The primary tumor was 6 mm thick. Melanoma cells were present microscopically at the cut end of the rectum. Because of her history of ischemic heart disease, the patient rejected our recommendation that she undergo radical surgery, and received 10 courses of carboplatin 20 mg intramuscularly and OK-432 10 K.E. (Klinische Einheit) intradermally every week. A single, pigmented metastatic inguinal lymph node developed and was excised in June 1987. A recurrent tumor was detected in the rectum in October 1992, so again we recommended radical surgery. The patient rejected radical surgery again, and received 12 courses of carboplatin 10 mg intramuscularly every 2 weeks. She died of disease at home in July 1993 after surviving for 7 years and 10 months. An autopsy was not performed. This case shows that local excision of the primary lesion may be appropriate to preserve the quality of life of patients with early-stage malignant melanoma of the anus.     

Clinical study on the pattern of lymphnode metastasis in carcinoma of esophagus (an analysis of 200 cases)

Objective: To study the pattern of lymphnode metastasis in carcinoma of esophagus. Methods: 200 cases of resected esophageal cancer specimens were carefully examined pathologically. Lymphnode metastasis, its pathway and extent in relation to pathological changes were analyzed. Results: Lymphnode metastasis was mainly regional and extended vertically in both directions. Leaping-over metastasis was another feature. The deeper invasion by the tumor, the higher frequencies of metastasis development, and vice versa. However, leaping-over metastasis was more likely to occur where tumor invasion was less severe. Conclusion: Owing to the high frequency of lymphnode metastasis in the superior mediastinum and the widely spanned leaping-over metastasis, an operative approach by three incisions through right thoracotomy with excision of the whole segment of esophagus and anastomosis at cervical region was recommended, in order to dissect lymphnodes in the cervical, thoracic and abdominal regions and to leave less or no metastatic lymphnodes behind.     

Frequency of pancreatitis after endoscopic retrograde cholangiopancreatography with iopromid or iotrolan: a randomized trial

Blood isotone contrast media is considered to be less toxic to vascular and pancreatic duct endothelium than high-osmolar contrast media. In this study we assessed the impact of a low-osmolar contrast agent compared with a blood isotone product on pancreatic damage induced by endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic retrograde sphincterotomy (EST). In a prospective trial 42 consecutive ERCP/EST patients were randomized to receive either iopromid, a low-osmolar non-ionic contrast agent (770 mosmol/kg H₂O), or iotrolan, a blood-isotone non-ionic product (320 mosmol/kg H₂O). The endoscopies were performed by two experienced endoscopists. Forty patients were included in the study. Blood samples were collected before and 40 min, 2, 4, 6 and 24 h after the endoscopic procedure. Samples were analysed for pancreatic serum enzymes, acute-phase proteins and blood counts. A clinical pain score was investigated. Post-ERCP pancreatitis was diagnosed in 2 patients in the iopromid group and in 5 patients in the iotrolan group. There was no significant difference between groups in the time course of pancreatic serum enzymes, acute-phase proteins or in the pain score. Due to the small number of patients in this study, only stronger differences caused by the two contrast media could have led to statistically significant results. We did not observe statistically significant differences in comparing iotrolan and iopromid concerning ERCP/EST-induced pancreatic damage. Received: 26 February 1999; Revised: 14 May 1999; Accepted: 9 June 1999     

胬肉切除联合球结膜瓣转位术的疗效

目的:探讨胬肉切除联合球结膜瓣转位术技巧及其疗效分析。方法:胬肉切除联合球结膜瓣转位术操作要点:术眼在表麻和浸润麻醉下,彻底切除胬肉及受累及的球筋膜组织。于上方球结膜下注入20g/L利多卡因使球结膜与结膜下组织分离,并作一条与角膜缘平行的带蒂球结膜瓣,将其转位覆盖在巩膜裸露区,并予缝合固定。术后用氯霉素地塞米松眼液滴眼,6～7d拆线。采用此术式治疗翼状胬肉患者379例(386眼),其中原发性翼状胬肉患者373例(380眼),复发性翼状胬肉患者6例(6眼)。结果:手术治愈373例(380眼),治愈率为98.4%;复发6例(6眼),复发率为1.6%。术后复发者经再次作手术,全部治愈。结论:胬肉切除联合球结膜瓣转位术治疗翼状胬肉效果显著,此术式值得推广应用。     

Favorable outcome after radical excision of a 'Holocord' astrocytoma

We report a favorable outcome following a staged radical excision of an intramedullary low-grade astrocytoma involving the entire spinal cord in a pediatric patient. Although the preoperative neurological status was poor, the eventual outcome was good. This highlights the importance of a good tumor-cord interface that permitted a radical excision of an extensive tumor. Since partial excision followed by radiotherapy usually results in disease progression in patients with low-grade astrocytomas, radical excision and follow-up is probably the treatment of choice.     

MRI and conservative treatment of locally advanced breast cancer

AIMS: The objectives of this study were to compare the efficacy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in assessing the response of primary breast carcinoma to neoadjuvant chemotherapy compared to conventional imaging modalities, and to see how surgical outcome was influenced as a result of these findings. METHODS: Thirty-four patients with locally advanced primary breast cancer underwent conventional imaging and DCE-MRI following six cycles of neoadjuvant chemotherapy prior to surgery. Changes in surgical management based on the post-chemotherapy DCE-MRI findings were recorded. RESULTS: Prior to neoadjuvant chemotherapy, 22 of the 34 patients were assessed as requiring mastectomy and the remaining 12 were considered inoperable. Following chemotherapy two patients were still considered inoperable. In 11 of the 34 patients, the final decision to proceed to either mastectomy or non-surgical management was based primarily on pre-treatment disease status or patient choice. DCE-MRI findings, therefore, contributed to the operative decision in 21 of 34 patients. Two of these 21 patients were spared surgery as DCE-MRI demonstrated complete response to chemotherapy and one declined surgery. The remaining 18 were able to undergo wide local excision, with only two patients subsequently requiring mastectomy for involved margins. CONCLUSIONS: DCE-MRI is able to accurately predict those patients suitable for breast conserving surgery following neoadjuvant chemotherapy and should be the imaging modality of choice in assessing the response of patients with primary breast carcinoma to neoadjuvant chemotherapy.     

Arthroscopic Management of Giant Meniscal Cysts Among Young Patients: An Average Three‐Year MRI Follow‐Up

ObjectiveTo describe an arthroscopic technique for giant meniscal cyst excision with preservation of the functional meniscus, report the short‐ and medium‐term outcomes, and assess magnetic resonance imaging (MRI) for follow‐up imaging evaluations.MethodsA total of 54 consecutive patients with symptomatic meniscal cysts were admitted to the Second Xiangya Hospital of Central South University between 2014 and 2019. Nine patients with giant meniscus cysts (six females and three males) were included in this study. The age range of the patients was 6–34 years. All patients underwent a complete physical examination, X‐ray, Doppler ultrasound, and MRI of the knee preoperatively. After an arthroscopic diagnosis of a meniscal rupture with a giant meniscal cyst, partial meniscectomy, ablation of the cyst, and suturing of the retainable meniscus were performed. Lysholm and International Knee Documentation Committee (IKDC) scores were used preoperatively and at the most recent follow‐up. Clinical outcomes were classified into four categories: excellent, good, fair, and poor. During the last visit, all patients underwent MRI to assess the recurrence of the cyst and meniscal suture healing.ResultsPreoperative MRI and arthroscopic examination revealed giant meniscal cysts combined with meniscal tears and congenital discoid meniscus, and all giant meniscal cysts occurred in the lateral meniscus. The main types of meniscal tears were horizontal and complex tears. The cysts were unicystic in one case and multicystic in eight cases. The mean size of the cysts on the MRI was 5.86 cm × 2.24 cm × 2.48 cm. The mean follow‐up periods were 37.5 (19–60) months. Clinical outcomes were excellent in six patients and good in three patients. The postoperative scores were significantly improved compared to the preoperative scores (Lysholm: 90.78 ± 4.60 vs. 54.56 ± 7.25; IKDC: 96.2 ± 3.46 vs. 61.69 ± 3.36; p <0.01). No recurrence of the cyst was indicated on the MRI, and there was good healing of the torn meniscus.ConclusionsArthroscopic cystectomy combined with the meniscus suture technique was effective to eradicate residual cyst cavities, and traffic orifices be highly recommended.     

Fibrin glue assisted amniotic membrane graft reconstruction of conjunctival fornix and canthus following excision of conjunctival tumours

Conjunctival tumors involving non-limbal locations, such as the fornix and canthus, are typically excised using a “non-touch” technique, often with a wide surgical margin. Reconstruction of these large defects can be difficult due to the contour of the ocular surface and are often complicated by shortening of the fornix, symblepharon formation, and restriction of eye movements. In our experience, the use of amniotic membrane grafts combined with the sealant properties of fibrin glue such as Tisseel® has improved our surgical outcomes during the reconstruction phase. We would like to highlight and describe our surgical technique using fibrin glue and squint hooks to aid amniotic membrane graft reconstruction for surgically challenging locations in the fornix and canthus following excision of conjunctival lesions, with excellent surgical outcomes.     

腹腔镜直肠癌全直肠系膜切除术32例报告

目的:评价腹腔镜全直肠系膜切除术的临床疗效.方法:回顾分析32例腹腔镜直肠全系膜切除术患者的临床资料.结果:30例用腹腔镜完成手术,手术时间160～240 min,平均195 min;术中平均出血150 mL,清除淋巴结总数平均为12.1个.术后均无严重并发症发生,随访1～3年无肿瘤复发,穿刺部位及造瘘口均无肿瘤种植....     

Linfadenitis por micobacterias no tuberculosas: experiencia de 15 años

Objective

To study the epidemiology, clinical features, diagnosis, therapeutic management, and outcome of non-tuberculous mycobacterial lymphadenitis in a paediatric population of Aragón (Spain).